health education

health education

UNIT FOUR

Working with Communities

Objectives 

At the end of this chapter, the trainees will be able to:

·        Explain the concept of community and community participation, in public health in general and health education and promotion in particular.

·        Describe the benefits of community participation in the achievement of health education programs.

·        Explore the mechanisms of achieving community mobilization for common goal and the role of community leaders towards such an endeavor.

Introduction 

In the past, health education follows persuasion approach to force behavior change among individuals. However, contemporary health education program underscores an informed decision-making approach emphasizing community participation and empowerment. When the idea of primary health care was launched, community participation was one of the important principles identified for its implementation. Although everyone talks about it, real community participation is rarely practiced.

What is community? 

Community could be defined as organized groups of people who share a sense of belonging, beliefs, norms, and leadership and who usually interact within a defined geographical area. 

The concept of community participation  

The health of the community will improve only if the people themselves become involved in planning, implementing, and having a say about their own health and health care. Nevertheless, involvement will not just happen.

Many people emphasize the importance of community participation for any development issues, including health promotion, to become a success. However, the question is how serious are we about involving individuals, families, and communities? Are we prepared - mentally and professionally – to listen to their concerns, to learn from them what they feel is important; to share with them appropriate information, to encourage and support them? Are we ready to assist them in choosing from alternative solutions, in setting their own targets and evaluating their own efforts? In many cases, so far, the answer is “NO”.

In health education, we are concerned about how people actually feel, not how we think they should feel. We are interested in how people look at their own problems, not only in the problems we see ourselves. We want people to develop the confidence and skills to help themselves.

The traditional approach in planning health care or health education program involves the decision to be made by experts. This approach is sometimes called the ‘top-down’ approach and contrasted with the ‘bottom-up’ approach where members of the community make the decisions. In this model people are just told what to do. We make decisions and expect them to follow.

The concept of community participation or involvement encompasses the process by which individuals and families assume responsibility for the community and develop the capacity to contribute to their health and the community’s development. It is a means by which the emphasis is on strengthening the capacity of communities to determine their own needs and take appropriate action. Communities should not be passive recipients of services.

The following are examples of actions that does not indicate genuine participation

·        Involvement of individuals from the community in responding to health assessment survey questionnaires,

·        Requesting the community members to contribute labor to dig a latrine for the school in its village,

·        Holding a meeting to ask people’s opinions on the issue of uncontrolled population growth,

·         Requesting mothers to bring their children to a clinic for vaccination

We may say communities are participating when they are actively involved in:

·        The assessment of the situation/needs 

·        Problem identification

·        Priority setting and making decisions

·        Sharing responsibility in the planning, implementing, monitoring and evaluation

 The role of experts should be limited to helping them identify their problems and to point out methods for dealing with the problems.

Benefits of community participation

·        It leads development endeavors to success.

·        Shifts the emphasis from the individual to the community e.g. If all members of a community are convinced of the benefits of cleanliness, they will help each other to find pure water sources and keep such sources clean.  They will build and use latrines everywhere in the community and keep them clean as well.

·        As communities often have detailed knowledge about their surroundings, their participation makes programs relevant to local situation.

·        Ensures community motivation and support. If the community is involved in choosing priorities and deciding on plans it is much more likely to become involved in program implementation and take up of the services because they are seen to be meeting their needs.

·        Promotes self-help and self-reliance. If community members do their own development work, they learn and become more conscious of their needs and potentials for solving their own problems, they make use of local skills, they learn to be responsible for projects and their maintenance, and they gain the necessary self-confidence to tackle further and perhaps more complicated development projects.

·        Improves trust and partnership between the community and health workers.

·        Enhances the implementation of the health extension package program.

Helping people to organize:

 The Role of Health Extension Workers

Success in community participation involves a series of overlapping stages.

 They include:

Knowing the community

·        Contacting with families, leaders and community groups.

·        Discussing on concerns and felt needs

Taking some actions:

·        Actions on achievable, short-term aims based on felt needs which bring the community together and build confidence.

Further activities and organization building

·        Build up-on existing community organization or associations.

·        Formation of committee e.g. Health committee

·        Educational in-puts • Select and train volunteers

·        Decision making on priorities

·        Further actions by the community themselves

In the process of promotion of community participation, community leaders are very essential.

Who are the leaders? 

A leader is a person whose ideas or actions influence others to get things done that the people want done. 

·        Could be a person of wisdom and sound judgment

·        Might be one whose advice has been valuable in the past.

·        Might be wealthy and powerful

·        Is known to be religious

Why are leaders important? 

·        Usually make decisions that result in success or failure of a project

·        They are trusted and the community members are ready to work with them.

·        Help people in the community know you and gain confidence in you.

·        Serve as an officer in an organization or chairperson of a committee.

In summary, the most important resources for the promotion of health are the people themselves. Through community participation, you can use that resource to improve the health of the people. However, successful community participation is not as simple as people may think. It requires a demanding task of working with the local communities, holding dialogue, initial teaching and awareness–raising activities, supporting community organization, and being able to convince and work with community leaders. However, overcoming all the challenges and achieving community participation require systematic and careful planning. Obviously, this is the usual challenge for the community health educators.

Exercise 

1. From your own local experience, describe how the ‘kebele’ heath committee functions and the role they have ever played in the improvement of the health of their people.

 2. Out line, the procedures you may follow to mobilize the local community for the development of spring in their village.

3. List down the perceived advantages of involving the community in every health education programs

UNIT FOUR

Working with Communities

Objectives 

At the end of this chapter, the trainees will be able to:

·        Explain the concept of community and community participation, in public health in general and health education and promotion in particular.

·        Describe the benefits of community participation in the achievement of health education programs.

·        Explore the mechanisms of achieving community mobilization for common goal and the role of community leaders towards such an endeavor.

Introduction 

In the past, health education follows persuasion approach to force behavior change among individuals. However, contemporary health education program underscores an informed decision-making approach emphasizing community participation and empowerment. When the idea of primary health care was launched, community participation was one of the important principles identified for its implementation. Although everyone talks about it, real community participation is rarely practiced.

What is community? 

Community could be defined as organized groups of people who share a sense of belonging, beliefs, norms, and leadership and who usually interact within a defined geographical area. 

The concept of community participation  

The health of the community will improve only if the people themselves become involved in planning, implementing, and having a say about their own health and health care. Nevertheless, involvement will not just happen.

Many people emphasize the importance of community participation for any development issues, including health promotion, to become a success. However, the question is how serious are we about involving individuals, families, and communities? Are we prepared - mentally and professionally – to listen to their concerns, to learn from them what they feel is important; to share with them appropriate information, to encourage and support them? Are we ready to assist them in choosing from alternative solutions, in setting their own targets and evaluating their own efforts? In many cases, so far, the answer is “NO”.

In health education, we are concerned about how people actually feel, not how we think they should feel. We are interested in how people look at their own problems, not only in the problems we see ourselves. We want people to develop the confidence and skills to help themselves.

The traditional approach in planning health care or health education program involves the decision to be made by experts. This approach is sometimes called the ‘top-down’ approach and contrasted with the ‘bottom-up’ approach where members of the community make the decisions. In this model people are just told what to do. We make decisions and expect them to follow.

The concept of community participation or involvement encompasses the process by which individuals and families assume responsibility for the community and develop the capacity to contribute to their health and the community’s development. It is a means by which the emphasis is on strengthening the capacity of communities to determine their own needs and take appropriate action. Communities should not be passive recipients of services.

The following are examples of actions that does not indicate genuine participation

·        Involvement of individuals from the community in responding to health assessment survey questionnaires,

·        Requesting the community members to contribute labor to dig a latrine for the school in its village,

·        Holding a meeting to ask people’s opinions on the issue of uncontrolled population growth,

·         Requesting mothers to bring their children to a clinic for vaccination

We may say communities are participating when they are actively involved in:

·        The assessment of the situation/needs 

·        Problem identification

·        Priority setting and making decisions

·        Sharing responsibility in the planning, implementing, monitoring and evaluation

 The role of experts should be limited to helping them identify their problems and to point out methods for dealing with the problems.

Benefits of community participation

·        It leads development endeavors to success.

·        Shifts the emphasis from the individual to the community e.g. If all members of a community are convinced of the benefits of cleanliness, they will help each other to find pure water sources and keep such sources clean.  They will build and use latrines everywhere in the community and keep them clean as well.

·        As communities often have detailed knowledge about their surroundings, their participation makes programs relevant to local situation.

·        Ensures community motivation and support. If the community is involved in choosing priorities and deciding on plans it is much more likely to become involved in program implementation and take up of the services because they are seen to be meeting their needs.

·        Promotes self-help and self-reliance. If community members do their own development work, they learn and become more conscious of their needs and potentials for solving their own problems, they make use of local skills, they learn to be responsible for projects and their maintenance, and they gain the necessary self-confidence to tackle further and perhaps more complicated development projects.

·        Improves trust and partnership between the community and health workers.

·        Enhances the implementation of the health extension package program.

Helping people to organize:

 The Role of Health Extension Workers

Success in community participation involves a series of overlapping stages.

 They include:

Knowing the community

·        Contacting with families, leaders and community groups.

·        Discussing on concerns and felt needs

Taking some actions:

·        Actions on achievable, short-term aims based on felt needs which bring the community together and build confidence.

Further activities and organization building

·        Build up-on existing community organization or associations.

·        Formation of committee e.g. Health committee

·        Educational in-puts • Select and train volunteers

·        Decision making on priorities

·        Further actions by the community themselves

In the process of promotion of community participation, community leaders are very essential.

Who are the leaders? 

A leader is a person whose ideas or actions influence others to get things done that the people want done. 

·        Could be a person of wisdom and sound judgment

·        Might be one whose advice has been valuable in the past.

·        Might be wealthy and powerful

·        Is known to be religious

Why are leaders important? 

·        Usually make decisions that result in success or failure of a project

·        They are trusted and the community members are ready to work with them.

·        Help people in the community know you and gain confidence in you.

·        Serve as an officer in an organization or chairperson of a committee.

In summary, the most important resources for the promotion of health are the people themselves. Through community participation, you can use that resource to improve the health of the people. However, successful community participation is not as simple as people may think. It requires a demanding task of working with the local communities, holding dialogue, initial teaching and awareness–raising activities, supporting community organization, and being able to convince and work with community leaders. However, overcoming all the challenges and achieving community participation require systematic and careful planning. Obviously, this is the usual challenge for the community health educators.

Exercise 

1. From your own local experience, describe how the ‘kebele’ heath committee functions and the role they have ever played in the improvement of the health of their people.

 2. Out line, the procedures you may follow to mobilize the local community for the development of spring in their village.

3. List down the perceived advantages of involving the community in every health education programs